Dental stem cell-derived exosomes and immunomodulation: a scoping review.

BACKGROUND: Dental mesenchymal stem-cell-derived small extracellular vesicles or exosomes have emerged as cell-free mediators of immune regulation; however, the evidence remains heterogeneous across stem cell sources, immune targets, disease models, and preparation methods. HIGHLIGHT: This PRISMA-ScR-guided scoping review mapped 74 eligible studies from five databases. Dental mesenchymal stem-cell-derived small extracellular vesicles were consistently associated with attenuation of inflammatory responses in vitro and in vivo, most commonly through suppression of IL-1β, IL-6, and TNF-α; elevation of IL-10 and TGF-β; and shifts from M1-like/pro-inflammatory towards M2-like/pro-resolution macrophage marker profiles. Periodontitis was the most frequent disease model, and dental pulp was the most common stem cell source. NF-κB emerged as the principal signalling convergence point; however, most mechanistic evidence remained context-specific, and adaptive immune responses were comparatively underexplored. CONCLUSION: Current evidence supports dental stem-cell-derived small extracellular vesicles as context-dependent immunomodulatory mediators that stabilize inflammatory microenvironments and may thereby permit downstream tissue repair. Translation will require standardised vesicle isolation, dosing, cargo characterisation, potency benchmarking, and longitudinal validation.